We Need to Talk About Our Eggs

WHEN I recently mentioned to a pregnant acquaintance that I was writing a book about egg freezing (and had frozen my own eggs in hopes of preserving my ability to have children well into my 40s), she replied, “You’re so lucky. I wish I had known to freeze my eggs.”

She was 40 years old and wanted two children, so she and her husband were planning to start trying to conceive a second child shortly after the birth of their first. “Now everything is a rush,” she said. Married at 38, she didn’t think to talk to her obstetrician-gynecologist about fertility before then. If her doctor had brought up the subject, she said, she might have put away some eggs when she was younger.

In our fertility-obsessed society, women can’t escape the message that it’s harder to get pregnant after 35. And yet, it’s not a conversation patients are having with the doctors they talk to about their most intimate issues — their OB-GYNs — unless they bring up the topic first. OB-GYNs routinely ask patients during their annual exams about their sexual histories and need for contraception, but often missing from the list is, “Do you plan to have a family?”

OB-GYNs are divided on whether it’s their responsibility to broach the topic with patients. Those who take an “ask me first” approach understandably don’t want to offend women who don’t want children, or frighten those who do. It doesn’t take much for an informational briefing to spiral into a teary heart-to-heart about dating woes. Do you reassure a distraught 38-year-old that she’s still got time; encourage her to seriously consider having a baby on her own; or freak her out so she settles for a lackluster relationship? And considering that fertility figures are averages (while one woman may need fertility treatment at age 36, another can get pregnant naturally at 42), when is the right age to sound the alarm?

But the biggest impediment to bringing the issue up was that doctors didn’t have many good recommendations for a single woman: she could either use an anonymous donor’s sperm to have a baby today, or she could fertilize her eggs with it and freeze the resulting embryos for future use.

Now, a better option is gaining credibility. Egg freezing (a technique that allows women to store their unfertilized eggs to use with a future partner when they are older) has been available in the United States since the early 2000s, but success rates at first were low and doctors have been hesitant to push it. The American Society for Reproductive Medicine said the technique shouldn’t be “offered or marketed as a means to defer reproductive aging,” and deemed it “experimental.”

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Last week, the doctors’ society announced that it was removing the experimental label (though it stopped short of endorsing widespread use of egg freezing to put off having children). After reviewing four randomized controlled trials, it found little difference in the effectiveness of using fresh or frozen eggs in in-vitro fertilization, and said that babies conceived from frozen eggs faced no increased risk of birth defects or developmental problems.

The procedure isn’t a panacea. It’s terribly expensive — often $10,000 to $15,000 — and is not usually covered by insurance. In addition, there’s a worrisome lack of data regarding the success rates of eggs frozen by the women at the end of their baby-making days. The majority of the women in the four studies reviewed by the society were under 35, and it warned against giving women who want to delay childbearing “false hope” that their frozen eggs will work when they are ready to get pregnant years later. Although estimates of the number of American women who have frozen their eggs for nonmedical reasons are in the thousands, very few have yet returned to thaw them — there are only a couple of thousand babies born from frozen eggs in the world.

Women should be allowed to come to their own conclusions and take their own risks — there’s a fine line between doctors’ “mentioning” and “suggesting” the procedure — but this is an option they should be hearing about from their OB-GYNs. To standardize the message, professional groups like the American Congress of Obstetricians and Gynecologists should create pamphlets that doctors can give to patients. OB-GYN residents also can learn suggested scripts that present the information in a nonbiased, nonalarmist way.

I first learned about egg freezing from a friend who had talked to her OB-GYN about whether she should freeze, given her family’s history of premature menopause. When I asked my doctor about the procedure, she said she had heard that the success rates had recently improved and gave me the name of a respected fertility doctor. As a result, I stashed away several batches of eggs between the ages of 36 and 38 — just before the cutoff at which many doctors no longer consider eggs worthwhile to save.

I was fortunate, because I knew to ask. We must go one step further and expect OB-GYNs to bring up family planning at every annual visit, so that women have the information they need to choose to take charge of their fertility. Perhaps more women will think about freezing in their early to mid-30s, when their chances of success are greater. Or maybe, after being asked about their plans from their very first visit, more will decide to start families when their eggs are at their prime, and won’t even need to freeze.

Sarah Elizabeth Richards is the author of the forthcoming book “Motherhood, Rescheduled: The New Frontier of Egg Freezing and the Women Who Tried It.”

A version of this op-ed appears in print on October 23, 2012, on Page A23 of the New York edition with the headline: We Need to Talk About Our Eggs. Today's Paper|Subscribe